Official publication of Rawalpindi Medical University
Diagnostic Validity Of Low Dose CT KUB In Demonstration Of Genitourinary Tract Calculi Compared To Normal Dose Ct Kub: A Provisional Study

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Keywords

Urolithiasis, ALARA, low dose CT KUB, stone density.

How to Cite

1.
Batool F, Rehman H, Mughal HH, Rauf K, Zia K, Abbas F. Diagnostic Validity Of Low Dose CT KUB In Demonstration Of Genitourinary Tract Calculi Compared To Normal Dose Ct Kub: A Provisional Study. JRMC [Internet]. 2023 Sep. 26 [cited 2024 Jun. 25];27(3). Available from: https://journalrmc.com/index.php/JRMC/article/view/2277

Abstract

Objective: Renal colic is a common clinical condition. Our objective is to evaluate the diagnostic accuracy of low dose CT KUB for detection of urinary stones, to minimize radiation dose to the patients, and to analyze diagnostic accuracy of LDCT KUB in comparison to standard dose CT KUB. We speculate the LDCT KUB may reduce patient radiation dose while maintaining diagnostic value.

Materials and Methods: This comparative cross sectional validation study was conducted at Department of Radiology in Benazir Bhutto Hospital, Rawalpindi June 2021 to Feb 2022. After approval of hospital ethical committee, a sample of 49 kidneys of 31 patients was collected by non-probability consecutive sampling technique. Included were the patients diagnosed with renal calculi referred from other departments. All the included patients were scanned by Toshiba Aquilion 16 slices, using automated tube current modulation, without any oral or IV contrast. CT scan started from diaphragm down to pubic symphysis with standard dose CT (SDCT) followed by low dose CT (LDCT). After the data was recorded, statistical package for social sciences, version 20.0 (SPSS Inc., Chicago, Illinois, USA) was used to analyse the data and generate results. Mean + standard deviation was calculated for qualitative data while frequency and percentage for qualitative variables. The means were compared by independent sample t test while the agreement between standard and low dose was depicted by kappa value.

Results: A total of 49 kidneys of 31 patients with renal stones was included in this study. The mean age of the patients ranged from 27 years to 48 years with a mean of 36.42 + 9.97 year. In gender distribution, 75.5 % (37) were male while 24.5 % (12) were females. More than half 59 % (29) were right while 41 % (20) were left kidneys.

Conclusion: This study demonstrated that LDCT was a productive and effective technique in the detection of urothelial stones despite considerable reduction in radiation dose and exposure as seen in SDCT.

https://doi.org/10.37939/jrmc.v27i3.2277

References

McCarthy CJ, Baliyan V, Kordbacheh H, Sajjad Z, Sahani D, Kambadakone A. Radiology of renal stone disease. Int J Surg. 2016 Dec;36(Pt D):638-646. doi: 10.1016/j.ijsu.2016.10.045. Epub 2016 Nov 2. PMID: 27816704.

Brisbane W, Bailey MR, Sorensen MD. An overview of kidney stone imaging techniques. Nat Rev Urol. 2016 Nov;13(11):654-662. doi: 10.1038/nrurol.2016.154. Epub 2016 Aug 31. PMID: 27578040; PMCID: PMC5443345.

Rodger F, Roditi G, Aboumarzouk OM. Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review. Urol Int. 2018;100(4):375-385. doi: 10.1159/000488062. Epub 2018 Apr 12. PMID: 29649823.

Xiang H, Chan M, Brown V, Huo YR, Chan L, Ridley L. Systematic review and meta-analysis of the diagnostic accuracy of low-dose computed tomography of the kidneys, ureters and bladder for urolithiasis. J Med Imaging Radiat Oncol. 2017 Oct;61(5):582-590. doi: 10.1111/1754-9485.12587. Epub 2017 Jan 31. PMID: 28139077

Drake T, Jain N, Bryant T, Wilson I, Somani BK. Should low-dose computed tomography kidneys, ureter and bladder be the new investigation of choice in suspected renal colic?: A systematic review. Indian J Urol. 2019 Jan;30(2):137-43. doi: 10.4103/0970-1591.126884. PMID: 24744508; PMCID: PMC3989811.

Neisius A, Thomas C, Roos FC, Jäger W, Tsaur I, Bartsch G, Knoll T, Haferkamp A. Steindiagnostik 2016 : Zuverlässig, effektiv und strahlungsarm. Urolithiasis: Reliable, effective and low radiation exposure]. Urologe A. 2016 Oct;55(10):1291-1296. German. doi: 10.1007/s00120-016-0231-1. PMID: 27637181.

Gervaise A, Gervaise-Henry C, Pernin M, Naulet P, Junca-Laplace C, Lapierre-Combes M. How to perform low-dose computed tomography for renal colic in clinical practice. Diagn Interv Imaging. 2016 Apr;97(4):393-400. doi: 10.1016/j.diii.2015.05.013. Epub 2015 Oct 27. PMID: 26522944.

Rob S, Bryant T, Wilson I, Somani BK. Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature. Clin Radiol. 2017 Jan;72(1):11-15. doi: 10.1016/j.crad.2016.10.005. Epub 2016 Oct 31. PMID: 27810168.

Weinrich JM, Bannas P, Regier M, Keller S, Kluth L, Adam G, Henes FO. Low-Dose CT for Evaluation of Suspected Urolithiasis: Diagnostic Yield for Assessment of Alternative Diagnoses. AJR Am J Roentgenol. 2018 Mar;210(3):557-563. doi: 10.2214/AJR.17.18552. Epub 2018 Jan 24. PMID: 29364722.

Hoffman RM, Atallah RP, Struble RD, Badgett RG. Lung Cancer Screening with Low-Dose CT: a Meta-Analysis. J Gen Intern Med. 2020 Oct;35(10):3015-3025. doi: 10.1007/s11606-020-05951-7. Epub 2020 Jun 24. PMID: 32583338; PMCID: PMC7573097.

Cheng RZ, Shkolyar E, Chang TC, Spradling K, Ganesan C, Song S, Pao AC, Leppert JT, Elliott CS, To'o K, Conti SL. Ultra-Low-Dose CT: An Effective Follow-Up Imaging Modality for Ureterolithiasis. J Endourol. 2020 Feb;34(2):139-144. doi: 10.1089/end.2019.0574. Epub 2020 Jan 10. PMID: 31663371.

Li X, Shu H, Zhang Y, Li X, Song J, Du J, Qian Y, Liu B, Yu Y. Low-dose CT with adaptive statistical iterative reconstruction for evaluation of urinary stone. Oncotarget. 2018 Apr 13;9(28):20103-20111. doi: 10.18632/oncotarget.25047. PMID: 29732006; PMCID: PMC5929449.

Bhatt K, Monga M, Remer EM. Low-Dose Computed Tomography in the Evaluation of Urolithiasis. J Endourol. 2015;29(5):504-11.

Licheng J, Yidong F, Ping W, Keqiang Y, Xueting W, Yingchen Z, Lei G, Jiyang D, Zhonghua X. Unenhanced low-dose versus standard-dose CT localization in patients with upper urinary calculi for minimally invasive percutaneous nephrolithotomy (MPCNL). Indian J Med Res. 2014 Mar;139(3):386-92. PMID: 24820832; PMCID: PMC4069732.

Shim YS, Park SH, Choi SJ, Ahn SJ, Pak SY, Jung H, Park SH. Comparison of sub millisievert CT with standard-dose CT for urolithiasis. Acta Radiol. 2020 Aug;61(8):1105-1115. doi: 10.1177/0284185119890088. Epub 2019 Dec 3. PMID: 31795730.

Gervaise A, Naulet P, Beuret F, Henry C, Pernin M, Portron Y, Lapierre-Combes M. Low-dose CT with automatic tube current modulation, adaptive statistical iterative reconstruction, and low tube voltage for the diagnosis of renal colic: impact of body mass index. AJR Am J Roentgenol. 2014 Mar;202(3):553-60. doi: 10.2214/AJR.13.11350. PMID: 24555591.

Yang B, Suhail N, Marais J, Brewin J. Do low dose CT-KUBs really expose patients to more radiation than plain abdominal radiographs? Urologia. 2021 Nov;88(4):362-368. doi: 10.1177/0391560321994443. Epub 2021 Feb 13. PMID: 33583356.

Li H, Jelley CR, Forster L, Arad J, Mudhar GS, Bardgett HP, Stewart AB, Forster JA. Ultra-low-dose CTKUB: the new standard of follow-up of ureteric calculi not visible on plain radiograph? Int Urol Nephrol. 2022 Apr;54(4):781-787. doi: 10.1007/s11255-022-03134-3. Epub 2022 Feb 7. PMID: 35129775.

Rawashdeh M, Saade C. Establishment of diagnostic reference levels in low-dose renal computed tomography. Acta Radiol. 2022 May 3:2841851221095238. doi: 10.1177/02841851221095238. Epub ahead of print. PMID: 35505591.

Alsyouf M, Smith DL, Olgin G, Heldt JP, Lightfoot M, Li R, et al. Comparing stone attenuation in low- and conventional-dose noncontrast computed tomography. J Endourol. 2014;28(6):704-7.

Danilovic A, Rocha BA, Marchini GS, Traxer O, Batagello C, Vicentini FC, Torricelli FCM, Srougi M, Nahas WC, Mazzucchi E. Computed tomography window affects kidney stones measurements. Int Braz J Urol. 2019 Sep-Oct;45(5):948-955. doi: 10.1590/S1677-5538.IBJU.2018.0819. PMID: 31268643; PMCID: PMC6844354

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Copyright (c) 2023 Fizza Batool, Hina Rehman, Hina Haneef Mughal, Kashif Rauf, Khadija Zia, Farhat Abbas